A Casual Look at PSHB Eligibility: 4 Facts That Clarify Who Can Access These Health Benefits

Key Takeaways

• The Postal Service Health Benefits (PSHB) Program provides health coverage for eligible USPS employees, retirees, and their families, but not everyone qualifies automatically.

• Enrollment requirements, eligibility timelines, and Medicare integration rules all play a role in determining whether you can access PSHB benefits.

Who Gets Access to PSHB? Understanding Eligibility for Postal Workers and Retirees

The Postal Service Health Benefits (PSHB) Program officially replaced the Federal Employees Health Benefits (FEHB) Program for Postal Service employees and retirees starting January 1, 2025. While this shift offers a dedicated healthcare program tailored to postal workers, eligibility rules are strict. So, how do you know if you qualify? Let’s break it down.

1. Active Postal Employees Must Be Enrolled in a PSHB Plan

If you’re currently working for the U.S. Postal Service, you’re required to enroll in a PSHB plan during Open Season unless you have coverage under a spouse or family member’s federal health plan. Your eligibility for PSHB is tied directly to your employment status, meaning:

• Full-time and part-time USPS employees are eligible for PSHB coverage.

• If you previously had FEHB coverage, you must select a PSHB plan during Open Season.

• Certain non-career employees may not qualify for PSHB but may have access to alternative healthcare options.

Unlike FEHB, where postal employees were grouped with the broader federal workforce, PSHB plans are designed exclusively for USPS workers, offering benefits specific to their needs.

2. Retirees Must Meet Specific Eligibility Requirements

Just because you worked for USPS in the past doesn’t mean you automatically qualify for PSHB in retirement. Retirees must meet eligibility criteria to maintain their health benefits. Here’s what that means for you:

• You must have retired with an immediate annuity under the Federal Employees Retirement System (FERS) or Civil Service Retirement System (CSRS).

• Deferred retirees (those who left USPS before reaching retirement age but plan to start an annuity later) are not eligible for PSHB.

• You must have been enrolled in an FEHB plan for at least five consecutive years before retirement to transition into PSHB coverage.

• Retired employees do not need to re-enroll; they are automatically moved into the corresponding PSHB plan if they were previously covered by FEHB.

3. Medicare Enrollment is Mandatory for Certain Retirees

If you’re retired and eligible for Medicare, your PSHB eligibility hinges on whether you enroll in Medicare Part B. Here’s how it works:

• Who Needs to Enroll in Medicare Part B? If you retired after January 1, 2025, and are 65 or older, you must enroll in Medicare Part B to maintain your PSHB coverage.

• Who is Exempt? Retirees who were already retired before January 1, 2025, are exempt from the Medicare Part B requirement and can keep PSHB without enrolling.

• If you fail to sign up for Medicare Part B when required, you risk losing your PSHB coverage altogether.

This new rule was introduced to align postal retirees with the general federal retiree healthcare system, where Medicare integration helps control costs for both enrollees and the system itself.

4. Family Members Have Eligibility Rules, Too

Your family members aren’t automatically covered just because you are. PSHB has specific rules regarding which dependents qualify for coverage:

• Spouses: Legally married spouses are eligible for PSHB.

• Children: Eligible children include biological, adopted, stepchildren, and foster children under the age of 26.

• Disabled Adult Children: If a child is disabled before age 26 and remains dependent, they may qualify for continued coverage.

• Former Spouses: If you’re divorced, your ex-spouse loses eligibility unless covered by a court-ordered decree (but even then, FEHB coverage options are more relevant than PSHB in this case).

Just like with FEHB, dependents can remain on your plan until they reach age 26, but they won’t qualify for PSHB after that unless they meet the criteria for disabled adult child coverage.

What Happens if You Lose Eligibility?

Losing PSHB eligibility doesn’t mean you’re left without options. Here’s what you need to know:

• If you separate from USPS before retirement without qualifying for an immediate annuity, you lose PSHB coverage.

• If you miss the Medicare Part B requirement (where applicable), you risk losing PSHB as a retiree.

• Family members who no longer qualify (such as children aging out) can look into individual health coverage options through the Marketplace.

For those who leave USPS employment but don’t yet qualify for PSHB, temporary continuation of coverage (TCC) is available for up to 18 months, but you must pay the full premium plus an administrative fee.

The Bottom Line on PSHB Eligibility

PSHB brings major changes to healthcare coverage for postal employees and retirees, but eligibility isn’t automatic. Active employees need to enroll during Open Season, retirees must meet strict requirements, and Medicare plays a crucial role in coverage for those 65 and older.

Want to make sure you’re covered? A licensed agent listed on this website can help you navigate eligibility, enrollment, and plan choices to ensure you’re making the right decision for your health and budget.